A Smart Man's Guide to Getting Laid in Middle Age

A Primer on Menopause that Won't Make you Cringe

Fully made up for my first boudoir photo shoot at the tender age of 44.

This week, a reader asked about the best ways to support his female partner through peri/menopause. I absolutely love that men are beginning to pay attention and ask questions about this totally natural but completely disorienting chapter in the lives of women.

Lots of symptoms can result from lack of estrogen and make people feel like a shell of their former selves. This is a non-exhaustive list:

• Hot flushes, Night sweats (AKA: vasomotor symptoms or VMS)

• Crippling insomnia

• Vaginal dryness and vulvar atrophy

• Painful sex

• Decreased libido

• Urinary incontinence and/or recurrent UTI

• Depression and/or anxiety

• Brain fog/decreased mental clarity

• Irritability

• Joint pain

• Muscle aches

• Decreased exercise tolerance

• Weight gain

• Increased abdominal fat

• Dry skin

• Hair loss

It sucks to have vague but very real symptoms that impact one’s quality of life and self-perception. These symptoms can also significantly impact occupational productivity and relationship satisfaction. Yet most doctors aren’t trained on how to take care of women through the transition. In fact, only 6.8% of surveyed OBGYN residents reported feeling adequately trained to manage menopause. For those interested, The Menopause Society has a database of certified professionals who specialize in this area. (I’m currently studying to take their certification exam in June.)

Despite the myriad of symptoms that can derail women’s health and quality of life in middle age, we can be unapologetic in our sexual prowess. There are a growing number of women speaking out about sexual health and exploration during this season of life.

Rebecca Ferguson

’s memoir, “3000 Orgasms” just hit #1 in Amazon’s sexual instruction category.

Miranda July

’s novel, “All Fours” about the sexual exploration of a 45 year old female artist, got a shoutout from the New York Times in an article called “Why Gen X-Women are Having the Best Sex”. Spoiler: It’s because we have the confidence and “Take No Shit” attitude to ask for what we want.

As a guy, validating your partner’s feelings is important. Not dismissing her very real symptoms or writing it off as just part of normal aging shows her that you care about her; mind, body and spirit. It also helps to be open to non-PIV sexual exploration and to avoid badgering her about sex when she’s just not feeling it.

What should guys know about Hormone Therapy?

I think of Menopause Hormone Therapy (MHT; formerly known as Hormone Replacement Therapy or HRT) as a necessary replacement to maintain physiologic function. People with hypothyroidism get thyroid hormone replacement. It baffles me why we don’t take the same approach with estrogen, progesterone and testosterone. It’s important to note that FDA approved uses for hormone therapy in women are:

1. Vasomotor Symptoms (hot flushes and night sweats)

2. Genito-Urinary syndrome of Menopause: symptoms include vulvo-vaginal atrophy, dryness, irritation, painful sex and recurrent urinary tract infections (UTI)

3. Prevention of osteoporosis; fracture is one of the leading causes of morbidity and mortality in post-menopausal women

Many clinicians in the women’s sexual health space believe that topical vaginal estrogen should be a staple of preventative maintenance for vulvar and vaginal health during and after menopause. Similar to watering a garden, topical vaginal estrogen used twice weekly provides the necessary cellular nourishment to maintain blood flow, lubrication and the cellular turnover required to prevent atrophy.

This maintenance regimen can certainly help with sexual function but maintaining one’s genital health is desirable regardless of sexual activity. A woman’s genital health is hers whether she chooses to share her vagina with someone else or not.

Ladies: Any doctor who tells you that you don’t need vaginal estrogen if you’re not having sex with a man should be fired and replaced by someone who actually cares about his/her patients.

Why Have We All Been Led to Believe that Hormones Cause Breast Cancer and Heart Disease?

The Women’s Health Initiative, the largest randomized-controlled trial of hormone therapy undertaken to date, made a lot of claims based on overcooked statistical analysis much or which turned out to be blatantly false. Similar to selling the public on the safety of opioid pain medications, the overstated claims about breast cancer risk in the WHI did incalculable medical damage to an entire generation of women. After the media blitz claiming that hormones increased the risk of breast cancer, the physicians and scientists involved didn’t want to risk their reputations and careers by walking back their very noisy and very wrong assertions. Doctors and scientists hate admitting when they’re wrong.

**A full explanation of the WHI is beyond the scope of this article but I encourage you to take a look at the Resources listed below for more comprehensive coverage of this important topic. Especially if you’re a clinician who takes care of women.

What else can guys do to support their female partners?

If you’re a regular reader of this Substack, you’re probably already thinking about expanding the definition of sex beyond penis-in-vagina (PIV) intercourse. A good arsenal of lubes and toys is key to exploring pleasure. Shopping together can be a fun adventure and a good way to open the lines of communication. Try checking out a new toy store in every city you visit together.

I’m a BIG fan of a good boudoir photo shoot as a way of boosting a woman’s confidence in her body! I know lots of women who have done this; either for themselves or as a gift experience from a partner. My favorite boudoir photographer in Las Vegas, Tanya Elyocoubi, has an amazing studio loft in the Art’s District that’s filled with clothing, furniture and props to create a portfolio of looks that will change the way a model views herself. I really can’t overstate how transformative the boudoir photoshoot can be. (FYI; this is an organic endorsement and I’m not getting kickbacks to say it.) Consider getting your partner a boudoir photoshoot as a Valentines Day gift in lieu of grocery store roses. You can thank me later for the suggestion.

Along with an understanding of her medical circumstances, accommodation of her sexual needs and a creative boost to her self-esteem, it’s vital to offer emotional support. Reassure her through your actions and words that, to you, she is the most extraordinary person in the world.

Resources:

Estrogen Matters: Why Taking Hormones in Menopause Can Improve and Lengthen Women's Lives -- Without Raising the Risk of Breast Cancer (2024 Revised and Updated Edition) Avrum Bluming, MD, and Carol Tavris, PhD

The Menopause Society Position Paper on Hormone Therapy (2022)

American College of Obstetricians and Gynecologists Supports the Use of Topical Vaginal Estrogen in Breast Cancer Survivors

Magnificent Sex: Lessons from Extraordinary Lovers by A. Ménard and Peggy Kleinplatz